A case report and review of literature: Tuberculous pericarditis with pericardial effusion as the only clinical manifestation

Abstract

Tuberculosis is a main cause of pericardial disease in developing countries. However, in patients with atypical clinical presentation, it can lead to misdiagnosis, missed diagnosis, and delayed treatment. In this study, we report a case of a 61-year-old woman admitted to the cardiac intensive care unit with "weakness and loss of appetite" and a large pericardial effusion shown by echocardiography. After hospitalization, a pericardiocentesis was performed, and the pericardial fluid was hemorrhagic. However, the Xpert MTB/RIF and T-SPOT tests were negative, and repeated phlegm antacid smears and culture of pericardial fluid did not reveal antacid bacilli. The patient eventually underwent thoracoscopic pericardial biopsy, which revealed extensive inflammatory cells and significant granulomas. Combined with the fact that the patient's pericardial effusion was exudate, the patient was considered to be suspected of tuberculous pericarditis (TBP) and given empirical anti-tuberculosis treatment the patient's symptoms improved and the final diagnosis was TBP. In this case report, it is further shown that a negative laboratory test cannot exclude tuberculosis infection. In recurrent unexplained pericardial effusions, the pericardial biopsy is feasible. In countries with a high burden of tuberculosis, empirical antituberculosis therapy may be used to treat the pericardial effusion that excludes other possible factors.

Keywords: case; diagnosis; pericardial effusion (PE); review; tuberculosis; tuberculous pericarditis (TBP).

FIGURE 1

Electrocardiogram shows that the patient has low voltage in the limb leads.

FIGURE 2

Echocardiography suggests the presence of a moderate to large pericardial effusion, as indicated by the red arrowhead.

FIGURE 3

There was scattered inflammation in both lungs, inflammatory nodules in the upper left and lower right lobes. Calcification in the left upper lobe, as shown in the red arrow in the figure. The radiologist considered it to be stable tuberculosis.

FIGURE 4

Chronic inflammatory cell infiltration was seen in the connective tissue granulomatous lesions and fibrous tissue hyperplasia were seen in the lymph nodes No necrosis was observed. As shown in the red circle.

FIGURE 5

Granulomatous lesions are seen within the fibrofatty tissue, as shown in the red circle.